No Exit

At 84 years old, the Deerfield Beach retiree was already in the advanced stages of pancreatic cancer and getting sicker every day. Kantofsky knew about the tolls of a prolonged death -- he'd cared for his own dying mother and father -- and he didn't want his sister, with whom he lived, to have to watch him wither away. "He told me, 'I don't want to take you with me,'" says Evelyn Messing, who is now 84. "He was afraid that if I had to take care of him while he was dying, I would get sick, too. He wanted me to be able to enjoy life while I had it."

Such kindness was typical of Kantofsky, Messing says, as when he gave his car away to her grandson when his sickness forced him to stop driving. He had routinely cared for ill friends.

Kantofsky's sickness sapped his strength. He lost weight; his clothes got baggy. The illness robbed him of his greatest pleasure in life: the taste of food. "A good sensible meal made him happy as a lark," Messing says. The cancer also ended his run as a local shuffleboard luminary. He'd earned trophies playing the game, as well as the nickname "the Analyzer," bestowed because of his thoughtful, calculated style of play. Now Kantofsky had little to do but analyze his situation, and it was grim.

He desperately wanted to get into a hospice program, where he could die with plenty of pain medicine, but was refused. (Medicare rules stipulate that a patient must have six months or less to live in order to be admitted.) The day came when he told his sister he was going to end his own life. "He said, 'I'm not going to wait until I'm skin and bones. I don't want to become a nothing person. I don't know how I'm going to do it, but I'll find a way,'" Messing recalls. She says he was at complete peace with his decision and that, until the end, he still made everyone around him, including his doctor, laugh with his good humor. When he told his doctor of his decision to end his own life, the doctor tried to persuade him to seek counseling. Kantofsky wouldn't think of it. "He told the doctor, 'That is ridiculous. Listen to me, do I sound crazy? I'm speaking intelligently and I know exactly what I'm doing,'" his sister says. The doctor laid off.

Despite his continuing cheerfulness, there was one thing Kantofsky rued: the fact that he had to kill himself without help.

"He thought Dr. Kevorkian was doing a wonderful thing," Messing says. "He said, 'How wonderful it is that these people die with dignity and how much better it is for the people who loved them.' But that option wasn't available for him. I wish it had been. I would have liked to have been with him when he died."

Instead, on the evening of April 6, 1999, while Messing napped on a couch in the living room, Kantofsky walked up to the fourth floor of their building at the Century Village retirement community. There, he used a step ladder to climb over the white concrete railing and jump to his death, landing in a large bush in a flower garden.

A friend of the family, George Horn, spotted Kantofsky's hand jutting from a bush. Horn began to cry and shake uncontrollably. He says he still has terrible flashbacks when he passes the spot where he found his friend.

Anyone who works at a daily newspaper can tell you why Kantofsky's story wasn't reported to the public: Newspapers and television stations simply don't cover suicide.

The only time a suicide makes the paper is if it involves a public figure or includes other crimes, such as homicide. The standard line is that suicide is an isolated, personal act that isn't newsworthy. Editors are also reluctant to cause survivors any additional pain by publicizing an act still widely considered shameful. This rationale is bolstered by a raft of suicide experts who claim that publicizing suicides may lead to a "contagion" effect -- copycat self-killers. "People must understand that the coverage of suicide may lead to the causation of suicide," says Karen Dunne-Maxim, president of the American Association of Suicidology and one of the most influential suicide experts in the country.

Dunne-Maxim, who speaks at conferences around the country on the subject of suicide and the media, maintains that the ideas and wishes voiced by Kantofsky can't be trusted. People really don't know why they commit suicide, and suicide notes lie, she notes. If Kantofsky's story is told, "it will come off like this man is generous," says Dunne-Maxim, who survived her brother's suicide. "It comes out like, 'Here's a way to solve the problem.'"

There is little doubt that Dunne-Maxim and her colleagues in the suicide-prevention field harbor the noblest of intentions. But they tend to overlook one crucial possibility, namely that Kantofsky's motives can be trusted. That his decision was not only rational but also compassionate. And that, in a culture less reflexively intolerant of suicide, Kantofsky might have found a more dignified way to end his life.

These views are becoming harder to discount. People age 65 and older are roughly 50 percent more likely to commit suicide than the rest of the population. White males over the age of 80 are at the greatest risk, killing themselves at six times the average rate. In Broward County, 51 seniors committed suicide in 1999. Many were lonely or depressed individuals who might have been aided by psychiatric care or counseling. But the majority of those who took their lives suffered from terminal or chronic illnesses and faced futures filled with pain, suffering, and staggering hospital bills.

One man who is exposed to the brutal reality of elderly suicide on a daily basis, Broward County Medical Examiner Joshua Perper, says he has come to support doctor-assisted suicide, if properly regulated. Seeing hundreds of grisly elderly suicides has influenced that decision, he says.

"Sometimes a person suffers beyond belief, and relief is not available," Perper says. "The life of that person is a living hell. Families suffer with the patients. It causes great emotional grief. People are tortured, and I don't believe people should ever be tortured."

In state houses and in Congress, debates are raging over doctor-assisted suicide. As baby boomers go gray and technology advances, more lives will be prolonged, often unintentionally adding to the suffering. Poll after poll shows that a majority of Americans support a terminal or chronically ill patient's right to die with a doctor's help. And yet such suicides are legal in only one state, Oregon, and a hotly debated federal bill threatens to make all doctor-assisted suicide illegal.

That means seniors such as Kantofsky will continue to take matters into their own hands. David McIntosh, a psychology professor at Indiana University and a leading expert on suicide among the elderly, says the media's tendency to ignore elderly suicides exacerbates the problem. While McIntosh agrees that a contagion effect can arise among adolescents, in the case of the elderly, he says, "talking about suicide doesn't cause suicide. It's just the opposite. People need to talk about it."

George Julian was a World War II hero who flew glider planes on missions behind enemy lines. He was also an accomplished pugilist who taught both boxing and judo in the military. But his lifelong love -- from the time he was a 14-year-old jockey -- was horseracing.

After years of traveling the country with his wife, Elsie, he settled down in Florida to work full-time training horses at Calder Race Course when it opened in 1971. Julian was headstrong and opinionated, making him a favorite in The Miami Herald sports pages, where he was quoted through the years on everything from the quirks of his horses to the history of racing. In 1990, when Julian's best horse ever, Run Turn, failed to make the Kentucky Derby, he told reporters: "I've been in the game since the 1930s. I never got to ride in a Derby or a Preakness. Now I wonder if I'm good enough to bring a horse there. Do you know what that would've meant to me? To my wife?"

Julian never did make the Derby, but he also never lost his love of racing and remained a fixture at the track, as did his dog, Benji, who Julian would fit with a bombardier's jacket on chilly mornings. Earlier this year when Benji was no longer allowed at the track by Calder's new owners, Julian feared his beloved dog might die from loneliness. About the same time, Julian himself became sick. Doctors found lesions on his liver. It was feared the 83-year-old had cancer. Within weeks the once-robust trainer was weak and thin and unable to make it to the track. Before tests were done to see if it was cancer, Julian crouched beside his bed and shot himself with a rifle. His wife, awakened by the blast, found his body in the corner of the room.

"He knew it was the end," Elsie Julian says. "He said, 'You know, I'm not going to get through this.' He always had to be on top. And killing himself was the easiest thing to do." She says people sometimes ask her, "How could he have done that to you?" Instead of dwelling on that unanswerable question, she likes to remember that her tough husband was also tender and brought her fresh-cut flowers every week for decades. He was 83 years old when he died. Benji is living out his old age at a farm.

What Elsie Julian saw when she walked into that room is too graphic to describe here. She doesn't like to talk about it -- in fact she, like many other survivors of suicide in the family, was reluctant to talk about her husband's suicide at all. The trauma of her husband's death, in fact, puts her -- and Horn in Kantofsky's case -- at risk for serious emotional problems, says psychology professor McIntosh.

They aren't alone. In Oregon, where a terminally ill patient can legally decide to take his or her own life, the method of death is decidedly peaceful. They take Pentothal, a powerful sedative. In a matter of minutes, the patient, often being comforted by loved ones, quietly dies. But in Florida and other states, the unavoidable consequence of suicide is carnage.

Guns were used in about half of the 1999 elderly suicides in Broward. Like Julian, many victims shot themselves in their houses, terrifying their spouses. On March 2, for instance, Edward Safer, age 85, suddenly took his wife's hand and kissed it and told her he loved her. At the same time, his nurse saw a 9 mm pistol in his hand and lunged for it. Safer shoved his wife away, forcing the nurse to catch her. Safer then backed into a walk-in closet of his Tamarac home, put the gun in his mouth, and ended his life. Safer was chronically ill at the time with heart problems and emphysema.

Megan Ingle says she's still reliving the nightmare of May 18, when she woke up to the smell of gunpowder after she and her husband, Roy, had gone to bed in their Miramar home. When she turned on the light, she saw a puddle of blood next to her husband's lifeless body beside her in the bed. When she reached for him, she knocked the gun to the floor. Her husband had a serious heart condition that required quadruple bypass surgery in 1991, and she says he'd developed an addiction to pain medicine. Ingle says she will never completely recover from the shock of that night. "I keep having a replay of finding Roy and of him lying there and me not being able to do anything. I think that will be with me to the end of my days."

Gun deaths aren't always instantaneous, as in the case of Sol Halpern, age 84, a retired attorney living in a condominium in Lauderhill. Halpern, who was suffering from terminal prostate cancer, shot himself in a chair near his condo's parking lot. The gunshot didn't kill him until several minutes afterward. Medics reported that he was still gurgling blood when they arrived.

Six seniors leapt to their deaths in 1999, the second most common method of suicide. Two seniors poisoned themselves, one with hydrochloric acid. Two men drowned themselves, one of them an ill 84-year-old Pompano Beach man who tied a weighted bag to his neck and jumped into the community pool, where he was found by a neighbor. One elderly man cut his wrists, and another burned himself to death in his Hollywood house.

Reliable statistics on the motives for suicide are not widely available, says professor McIntosh. "The reasons aren't put on death certificates," he notes. But studies suggest that most suicides -- elderly and otherwise -- are the result of serious illness. In 1996, the last year the Broward medical examiner conducted a study on suicide, researchers found that 122 of the 222 total suicides, or 55 percent, were caused by health problems.

In the case of the elderly, this percentage is even higher. An analysis of Broward's 51 elderly suicides in 1999 reveals that the majority of cases were rooted in either illness or physical pain or both. A sample of cases:

January 12: Moe Borenstein, age 90, shot himself in bed at his Tamarac home. Borenstein's bones were crumbling from osteoporosis. His prostate and groin were riddled with cancer, his shoulder and neck ached terribly, and he'd just had two melanomas removed from his face. He couldn't move without pain. He sometimes talked of suicide before finally killing himself.

January 14: Fred Landesco, age 81, overdosed on his own medication in his Pompano Beach home, where he lived alone. He'd talked of suicide often and had a laundry list of health problems -- including blindness, a hip fracture, emphysema, and heart disease -- that confined him to bed.

February 12: Joseph Vesey, age 83, shot himself on his third-floor condo patio in Hillsboro Beach. His doctor told investigators that the act wasn't surprising: Vesey suffered from severe emphysema, required containers of oxygen to survive, and was suffering terribly. He left behind a living will and instructions for cremation.

August 13: Leon Greenblatt, age 83, shot himself on his condo patio at Century Village. Greenblatt, who was suffering from terminal lung cancer, called Hospice Home Care By-the-Sea, which cared for him, and got a receptionist on the phone. He told her that he was going to kill himself. She then heard the gunshot blast.

August 31: Sam Stoller, age 90, ran his car in his closed garage until he died of carbon monoxide poisoning. Stoller, who was suffering from cancer, had tried to shoot himself five days earlier but was caught by his daughter while he loaded his gun. Nearby was a brief, fragmented suicide note, written in a shaky hand: "Sorry, I can't take any more my body hurts so goodbye." His daughter took the gun away and took him to his doctor, who arranged for a counselor to stay with him. After spending the day with him, the counselor left at 7:45 p.m. She was the last person to see him alive.

To Mary Hudson it comes as no surprise that records of these senior suicides are kept hidden from public view in a little storage room at the medical examiner's office. "It's like an evil secret," says Hudson, Broward's representative for the Hemlock Society, a group dedicated to providing instructions to terminally ill patients who wish to end their lives with a minimum of trauma. "If more attention were brought to the problem, maybe people would actually start doing something to try to make things better." She views legalized doctor-assisted suicide as the ideal solution.

Perper, Broward's medical examiner, agrees. So do the majority of Americans, according to Gallup, which announced last year that 61 percent of Americans support a terminal patient's right to die.

Perper notes, however, that the issue of assisted suicide is too dark a subject to be championed by most politicians. The opposition, while limited, is extremely vocal, led by the Catholic Church and conservative Christian political groups like the Christian Coalition and Fort Lauderdale's Center For Reclaiming America.

"It is a very deep religious problem at the very core," says Perper, who has studied the issue extensively. "Many religious faiths believe that God gives life and you cannot reject that gift. You got it and you can't discontinue it, or you are in violation of God's will."

The assisted-suicide controversy has a number of parallels to the abortion debate. In both cases a vocal minority has invoked the sanctity of life in an attempt to block acts they consider immoral. While women now have a right to abortion, most terminally or chronically ill patients who wish to end their lives in a dignified manner still must go it alone. And the parade of grisly self-inflicted deaths continues.

One of the most disturbing suicides of 1999 was that of Thomas Reynolds, age 74, who drank a half-bottle of Cygon 2E. The home-and-garden insecticide was still in his stomach and emitting a "strong, noxious odor" when he was autopsied. Reynolds, according to reports, helped the insecticide down with a bottle of vodka. He'd already arranged to be cremated before drinking this unfathomable cocktail.

Reynolds' death is a good example of how complicated the issue of elderly suicide can be. It's not all physical sickness. Reynolds suffered a heart condition, but records show that the cause of his suicide was heartbreak: His wife had died 23 days before his own death. His suicide goes to the heart of another scourge for senior citizens: untreated depression.

Consider the case of Osvaldo Suarez. Suarez had a heart condition that required bypass surgery in June 1998. His health problems forced him to quit his job at a grocery store -- the first time he hadn't worked for a living since he escaped from Cuba (and was rescued at sea) on a raft 30 years earlier. He became depressed. According to investigators, he mentioned suicide a week before he hung himself from his bird aviary in the back yard of his Hollywood home. One of his sons, who'd recently arrived in America from Cuba, found his body.

His wife, Beverly Suarez, a nurse who has worked with suffering older patients, says she believes the reason he killed himself was untreated depression caused by his bypass surgery. She says she frequently sees depression in veterans of bypass surgery at the hospital where she works. "For a man it is critical that they are functional," she says. "Some can cope and some can't. A lot of their problems seem to stem from a sense of hopelessness; they can't take care of themselves, they can't drive, monetary things. Maybe they can't have sex. They get more and more depressed. I really think a study needs to be done on the correlation between bypass surgery and depression and suicide."

Indeed depression is linked to almost all elderly suicides, often prompted by health problems or loneliness. McIntosh says research shows that most depression in the elderly goes untreated. Suarez is the rule, not the exception.

McIntosh stresses that the mental shock of finding out -- or even suspecting -- grave illness is often enough to prompt suicide, and Broward had several such cases in 1999, including George Julian's. Albert Lorenz, for instance. Lorenz, age 83, cared for his first wife until she died after a protracted battle with cancer. He often told his second wife, Virginia, that he'd never let an ambulance take him from his house. He'd kill himself first, he told her. On May 28, Lorenz, a retired salesman living in Coconut Creek, woke up and couldn't get out of bed. He told Virginia he thought he'd had a stroke. When she went to call 911, he forbid her to dial and told her to leave him alone. She heard a gunshot and found him facedown on the floor with a gunshot wound to the head. He died later at North Broward Medical Center.

McIntosh and Perper agree that cases like Lorenz's might be avoided if doctors and their staff work harder to identify depression and suicidal tendencies in those who receive devastating diagnoses. One Broward doctor, who spoke on condition of anonymity, says that trying to pick out potential suicides among those who receive grim medical news is next to impossible. "Bottom line: People respond differently," says the doctor, a general practitioner who also directs a nursing home. "And personally I don't blame them for choosing [suicide]. The suffering that goes on is unbelievable."

The doctor strongly encourages the use of living wills, which dictate that life-prolonging machines like respirators will be discontinued if the patient is terminally ill and in such poor shape that he can no longer communicate. Living wills, the doctor says, spare patients and their families the long and costly deaths that come courtesy of modern technology. He also is a strong believer in hospice programs -- which dispense large amounts of morphine to patients to ease their suffering as they die. But as Kantofsky's case shows, not everyone can get into hospice programs, and many suffering patients don't want to deteriorate to the point that a hospice will take them.

For the depressed elderly, there is help available throughout South Florida, including the Henderson Mental Health Center in Fort Lauderdale, which has a 24-hour walk-in clinic and a mobile unit with two teams of counselors who cover all of Broward and make house calls.

"There are solutions for people; there are mental health services," McIntosh says. "There are ways to lessen the psychological pain, and it's important that people know that."

But even McIntosh concedes that treatment is far from foolproof. In the case of many ill seniors, particularly those who have lost spouses, depression is normal, and difficult to treat. In the case of someone like Sam Stoller, not even a professional aide staying at his house was enough to dissuade him from taking his own life. As his suicide note indicates, he'd made up his mind.

So had Kantofsky. But his sister insists he was never depressed -- just realistic. She says she initially tried to talk him out of it but came to believe that he had made his decision and that it was a sound one. She didn't want to see him be tortured by cancer, either. "He told me, 'If I had the power, I would tell the people in government that a person has the right to die with dignity. He should get an injection so he can die as a human being and not as skin and bones.'"

Kantofsky is dead, and the man he considered a hero, Dr. Jack Kevorkian, is in prison on a murder conviction. But the issue of assisted suicide is expected to become only more pressing. The White House issued a press release last year stating that the number of senior citizens in the United States will double by the year 2030, rocketing from 34.3 million to 69.4 million. Thanks to technology these seniors will likely lead longer lives.

McIntosh knows about these numbers and says they make him literally cringe. On a personal level, the psychologist says he doesn't believe that doctor-assisted suicide should be legalized, in part because of his Christian beliefs.

Still, hearing Kantofsky's story seems to make McIntosh ambivalent on the right-to-die issue, at least when it comes to the former shuffleboard champ at Century Village. "What he did is very hard to argue with," McIntosh says. "It's very hard to come out against what he did. These stories need to be told so that everyone can understand the issues involved in this debate, because this problem is definitely not going to go away. It's only going to get worse."